Evaluation of the healing and protective properties of adipose-derived mesenchymal stem cells from cisplatin-induced liver and kidney damage.

OBJECTIVE: The occurrence of nephrotoxicity and hepatotoxicity as a result of cisplatin administration is a major concern in clinical practice. This study examined the potential protective effects of administering mesenchymal stem cells (MSCs) on the renal and hepatic damage caused by cisplatin. Moreover, the study investigated the potential protective effects of administering Adipose-Derived Mesenchymal Stem Cells (ADMSC) to counteract the harmful effects of cisplatin-induced kidney and liver damage. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into three groups: normal control, cisplatin + saline, and cisplatin + ADMSC. Cisplatin was administered to induce toxicity, and ADMSC was administered intravenously as a potential therapeutic intervention. Biochemical parameters and histopathological changes were assessed in the kidney and liver tissues. Statistical analyses were performed using a one-way ANOVA. RESULTS: Cisplatin increased malondialdehyde (MDA), tumor necrosis factor alfa (TNF-alfa), IL-6, alanine transaminase (ALT), creatinine, Galectin-3, Tissue growth factor beta 1 (TGF-beta 1), compared to the normal control group. Cisplatin-MSC reduced these levels. Histopathology showed that cisplatin caused kidney tubular epithelial necrosis, luminal necrotic debris, tubular dilatation, interstitial inflammation, liver sinusoidal and central vein dilatation, congestion, necrosis, and cytoplasmic vacuolization. ADMSC administration significantly reduced histopathological changes. CONCLUSIONS: These findings highlight the potential therapeutic benefits of mesenchymal stem cell (MSC) administration in mitigating cisplatin-induced nephrotoxicity and hepatotoxicity. MSC treatment demonstrated protective effects by reducing oxidative stress, inflammatory markers, and histopathological alterations. Further investigations are warranted to elucidate the precise mechanisms underlying these protective effects and evaluate their clinical implications for managing cisplatin-induced organ damage.

Is near-infrared spectroscopy a promising predictor for early intracranial hemorrhage diagnosis in the Emergency Department?

Intracranial hemorrhage (ICH) is a serious medical condition that can lead to significant morbidity and mortality if not diagnosed and treated promptly. Early detection and treatment are essential for improving the outcome in patients with ICH. Near-infrared spectroscopy (NIRS) is a non-invasive imaging technique that has been used to detect changes in brain tissue oxygenation and blood flow in various conditions. The aim of this study was to investigate the predictive potential of NIRS for early diagnosis of ICH in patients presenting to the Emergency Department (ED) triage with headache. A total of 378 patients were included in the study. According to the final diagnosis of the patients, 4 groups were formed: migraine, tension-cluster headache, intracranial hemorrhage and intracranial mass, and control group. Cerebral NIRS values "rSO2" were measured at the first professional medical contact with the patient. The right and left rSO2 (RrSO2, LrSO2) were significantly lower and the rSO2 difference was significantly higher in the intracranial hemorrhage group compared to all other patient groups (P<0.001). The cut-off values determined in the receiver operating characteristics (ROC) analysis were RrSO2 ≤67, LrSO2 ≤67, and ΔrSO2 ≥9. This study found that a difference of more than 9 in cerebral right-left NIRS values can be a non-invasive, easy-to-administer, rapid, and reliable diagnostic test for early detection of intracranial bleeding. NIRS holds promise as an objective method in ED triage for patients with intracranial hemorrhage. However, further research is needed to fully understand the potential benefits and limitations of this method.

The improved killing of both androgen-dependent and independent prostate cancer cells by etoposide loaded SPIONs coupled with NIR irradiation.

Etoposide (Eto) is a toxic drug that shows promise in treating prostate cancer (PCa) but confers significant side effects, and has poor solubility and bioavailability. Nanoparticles are quite successful in overcoming such problems. Multifunctional nanoparticles that provide an opportunity to perform combination therapy have attracted great interest in recent years. Superparamagnetic iron oxide nanoparticles (SPIONs) are popular in various biomedical applications, including magnetic resonance imaging, drug delivery, magnetic hyperthermia and recently in photothermal therapy, combining imaging with therapy. Here, for the enhanced killing of PCa cells that are either androgen-dependent or not, the combination of SPION based Eto delivery and mild hyperthermia triggered by laser irradiation is proposed for the first time in the literature. For the encapsulation of Eto, highly stable, small, polyacrylic acid coated SPIONs were conjugated with bovine serum albumin (BSA) (Eto-BSA@PAA@SPION). Eto-BSA@PAA@SPION with 9% drug content produced better chemotherapeutic outcomes than free Eto on both androgen-dependent/castration sensitive LNCaP and androgen-independent/castration-resistant PC3 and DU145 PCa cells by enhancing drug internalization. Single and short irradiation of Eto-BSA@PAA@SPION treated cells at 808 nm improved the drug release and sensitized cells for Eto, hence, increasing the toxicity dramatically in all studied PCa cell lines. Caspase-mediated apoptosis, DNA damage, and ROS generation were detected in the treated cells, increasing with the Eto dose and laser treatment. The IC50 for Eto is reduced to 0.08 µg mL-1, 0.13 µg mL-1 and 2.8 µg mL-1 with laser/Eto-BSA@PAA@SPION for LNCaP, DU145 and PC3 cells, respectively. These are the lowest IC50 values seen in the literature for Eto on these cell lines so far, suggesting that the demonstrated nanoparticles and treatment approaches have great potential to treat various PCa cells at low doses of the drug under mild laser treatment conditions.

The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors.

OBJECTIVE: To analyze the predictive factors for residual tumors in the second resection after the initial transurethral resection of bladder tumor (TUR-BT) in patients with pT1 tumors and to develop a simple method to predict the probability of residual tumor detection. MATERIAL AND METHODS: Patients with pT1 bladder cancer who underwent a second resection within two to six weeks after the initial TUR-BT were included in our retrospective study. The patients' demographics and the tumor characteristics of the initial and second resections were recorded. RESULTS: A total of 144 patients were included in our analysis with a 53-month follow-up. In the univariate logistic regression analysis, tumor grade, concomitant carcinoma in situ (CIS), macroscopic appearance of the tumor (solid vs papillary), and presence of a variant histology, were significant risk factors for residual tumor. In the multivariate analysis, tumor grade was the only independent predictor of residual tumor at second TUR (OR: 5.62, 95% CI: 1.228-25.708, p = 0.026). According to our findings, the patients with the highest risk have a 90.9% residual tumor detection probability at the second resection, and the patients with the lowest risk have 25.4%. CONCLUSIONS: Tumor grade, macroscopic appearance of the tumor (solid vs papillary), and concomitant CIS, were important predictors of residual tumors at second resection of primary pT1 NMIBC patients. We were able to calculate the probability of residual tumor which helped us determine risk adapted strategies according to these probabilities.

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

BACKGROUND: Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. METHODS: A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. RESULTS: Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97 mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79 mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9 mm on the right and 24.2 mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35 mm and 4.62 mm at 2 cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2 cm below the SHP bifurcation. CONCLUSIONS: Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

Real world results of venetoclax combined with hypomethylating agents in relapsed/refractory AML.

OBJECTIVE: Relapsed/refractory AML cases are much more resistant to chemotherapy. Venetoclax is a highly sensitive BCL-2 inhibitor. It was aimed to evaluate the effects of venetoclax therapy on real-world R/R AML survival outcomes, the effects of the cytogenetic characteristics of the patients and previous clinical applications on treatment response, and venetoclax treatment toxicity. PATIENTS AND METHODS: The study included patients who only received a venetoclax-based salvage on R/R AML patients from Turkey. The study included a total of 62 patients from 6 different centers in Turkey. Response to 2 cycles of venetoclax treatment was assessed by bone marrow blast rate. The demographic data, cytogenetic characteristics, AML type, MDS type, response rates and overall survival of the patients after venetoclax combination treatment were assessed. Median age of the patients was 65 (19-85). Mean number of prior treatments was 2.67 ±1.75. RESULTS: 13 patients (21%) had a history of allogenic stem cell transplantation. 58 (93.5%) had received HMA therapy before venetoclax. 36 patients (58.1%) had de-novo AML, and 25 (40.3%) previously had MDS. Treatment response was evaluated as complete remission (n = 21, 33.9%), partial response (n = 17, 27.4%), and treatment failure (n = 24, 38.7%). Patients in the TF group were significantly more likely to have poor cytogenetic and to have received allogeneic transplants. The mean estimated overall survival after the venetoclax treatment was 9.13 ± 0.75 months. CONCLUSIONS: The study population consisted of a group of patients who had relapsed or primary refractory disease with poor prognosis, despite numerous rounds of chemotherapy. It is our belief that the high response rates obtained with the combination of venetoclax/HMA, and having obtained positive results with poor risk patients, indicated a promising perspective for R/R AML patients.

Investigation of the factors affecting the photothermal therapy potential of small iron oxide nanoparticles over the 730-840 nm spectral region.

The use of superparamagnetic iron oxide nanoparticles (SPIONs) as a sensitizer in photothermal therapy (PTT) is relatively new and the origin of such a phenomenon is not known. Usually, large crystals and aggregated particles are preferred in the literature, suggesting that these increase the absorbance of particles at the irradiation wavelength, and hence, provide a larger temperature increase. This study has two major goals: identification of the key factors that affect the photo-induced temperature increase in well-controlled experiments and the influence of laser irradiation on nanoparticle properties. Small, biocompatible poly(acrylic acid) coated SPIONs (PAA/SPIONs) were used since they are more practical for future medical use than large aggregates. We studied the impact of three major laser-dependent variables, namely the wavelength (between 728 and 838 nm), intensity (1.85-9.76 W cm-2) and power (105-800 mW) as well as attenuation at the irradiation wavelength, on photothermal heating achieved with PAA/SPIONs. Within the studied range of these variables, only the laser power plays a critical role on the magnitude of photothermal heating in solutions. There is no strong correlation between the attenuation at the excitation wavelength and the temperature increase. In addition, extensive characterization of SPIONs before and after irradiation revealed no significant difference, which supports the re-usability of SPIONs. Lastly, the PTT potential of these small PAA/SPIONs was demonstrated in vitro on HeLa cells. At these low laser powers no temperature increase in SPION-free water or cell death in SPION-free cells was detected. Hence, this study provides a new insight into the photothermal effect of SPIONs, provides a clear and repeatable experimental procedure and demonstrates great potential for small SPIONs to be exploited in PTT.

The Reversal of Stoma Following Open Abdomen Management.

Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.

Laparoscopic Treatment of Type III Mirizzi Syndrome by T-Tube Drainage.

Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann's pouch that mechanically obstructs the common bile duct. We would like to report laparoscopic treatment of type III MS. A 75-year-old man was admitted with the complaint of abdominal pain and jaundice. The patient was accepted as MS type III according to radiological imaging and intraoperative view. Laparoscopic subtotal cholecystectomy, extraction of impacted stone by opening anterior surface of dilated cystic duct and choledochus, and repair of this opening by using the remaining part of gallbladder over the T-tube drainage were performed in a patient with type III MS. Application of reinforcement suture over stump was done in light of the checking with oliclinomel N4 injection trough the T-tube. At the 18-month follow-up, he was symptom-free with normal liver function tests.

One step emission tunable synthesis of PEG coated Ag2S NIR quantum dots and the development of receptor targeted drug delivery vehicles thereof.

PEGylation of quantum dots (QDs) to decrease their toxicity, increase blood circulation time, reduce non-specific uptake and also to solubilize and stabilize hydrophobic QDs in aqueous medium is a widely used approach and many different methods were developed to achieve this. QDs that are luminescent in the near-infrared region (NIR) have recently emerged as the more appropriate materials for bio-imaging studies. In this work, we describe a single step emission tunable aqueous synthesis of PEGylated Ag2S NIRQDs. They are highly cytocompatible, not only due to the PEG coating but also due to the intrinsic biocompatibility of Ag2S, and prepared in a single step aqueous method using thiolated PEGs as the only coating material. Tuning the emission wavelength within the medical window (775-930 nm) with a quantum yield between 2 and 65% is achieved by changing the reaction variables such as PEG molecular weight, pH and precursor ratios. Ag2S-PEG NIRQDs prepared from 5 kDa MPEG-SH at acidic pH provided a dramatic enhancement in the luminescence intensity. These NIRQDs were also designed with surface functional groups to attach folic acid and loaded with doxorubicin (DOX) which dramatically enhanced the uptake and efficacy of DOX (50% cell death with 15 nM DOX) in FA-receptor overexpressed cancer cell lines (HeLa). They also showed a strong cytoplasmic NIR signal in the in vitro studies, demonstrating great theranostic potential.

Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal.

Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA) with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT). Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

Dental stem cell sources and their potentials for bone tissue engineering.

Tissue engineering arouses excitement in all medical fields that deal with bone healing. The ultimate aim of these approaches are to shorten the healing process, obtain highly differentiated functional tissues and eliminate the need for a second surgical site required for autogenous bone grafts. Mesenchymal stem cells have been increasingly used in the experiments which were conducted in these fields and the results are promising. Dental stem cells have come to the forefront both because of their relative ease of access and also their superior characteristics. This article investigates the importance of dental stem cells for bone tissue engineering and their regeneration potentials.

Acupuncture points in the book of Serefeddin Sabuncuoglu, a 15th century Turkish physician.

Serefeddin Sabuncuoglu (1385-1468?), the author of Cerrahiyetü'l-Haniyye (Imperial Surgery), was a distinguished Ottoman Turkish surgeon. The first illustrated Turkish surgical textbook, Cerrahiyetü'l-Haniyye consisted of three chapters (ie, cauterisation treatments, surgical procedures and fractures and dislocations). Although the main source of the book was Al-Tasrif (Textbook of Surgery) by Albucasis (Abu al-Qasim al-Zahrawi; 936-1013 AD), Sabuncuoglu added much new information, his clinical experiences and suggestions. The original illustrations and human figures made Cerrahiyetü'l-Haniyye the first illustrated medical textbook in Turkish and Islamic medicine literature. Cerrahiyetü'l-Haniyye was also a valuable source for acupuncturists. Some new sections and additions revealed that Sabuncuoglu had knowledge of Chinese medicine. In four sections of Cerrahiyetü'l-Haniyye (ie, toothache, haemorrhoids, eczema and dermatophytosis) Sabuncuoglu described acupuncture techniques and point locations. It is likely that the Chinese medicine content of Cerrahiyetü'l-Haniyye was derived from Central Asian roots of Anatolian Turkish people.

Management of Recurrent Rectourethral Fistula by York Mason Posterior Transrectal Transsphincteric Approach.

Rectourethral fistula (RUF) may develop after ureterovesical and rectal intervention or radiation therapy (RT) rarely, but it is associated with significant morbidity and mortality. The patient will typically present with pneumaturia, faecaluria, and urinary drainage from the rectum. Diagnosis can be easily done with digital rectal examination, cystography, and urethrocystoscopy. Conservative supportive management of RUF does not appear to be successful in most patients, and management with surgical intervention remains the best treatment option. Several surgical techniques have been described including transabdominal, transanal, transperineal, combined abdominoperineal, anterior and posterior transsphincteric, transsacral, laparoscopic, robotic, and endoscopic minimally invasive approaches. There have been very few data about treatment of recurrent RUF. We would like to report the management of recurrent RUF following transurethral resection of prostate and RT for prostate carcinoma in an immunosuppressed, 75-year-old patient by York Mason posterior transrectal transsphincteric approach.

Targeted delivery of doxorubicin into tumor cells via MMP-sensitive PEG hydrogel-coated magnetic iron oxide nanoparticles (MIONPs).

Targeting tumors with nano-scale delivery systems shows promise to improve the therapeutic effects of chemotherapeutic drugs. However, the limited specificity of current nano-scale systems for cancer tissues prevents realization of their full clinical potential. Here, we demonstrate an effective approach to creating as targeted nanocarriers for drug delivery: MIONPs coated with integrin-targeted and matrix-metalloproteinase (MMP)-sensitive PEG hydrogel scaffolds. The functional PEG hydrogel coating has been designed for active loading as well as triggered intra-cellular release of the cancer therapeutic agent doxorubicin (DOX). Our study demonstrated that coated nanocarriers could be taken into cancer cells 11 times more efficiently than uncoated ones. Furthermore, confocal laser scanning microscopy images revealed that these targeted nanocarriers could efficiently deliver and release DOX into the nuclei of HeLa cells within 2h. Coating MIONPs with multifunctional PEG hydrogel could be a promising alternative to existing vehicles for targeted delivery of DOX into tumor tissue.

Does the STOP-Bang, an obstructive sleep apnea screening tool, predict difficult intubation?

OBJECTIVE: A close relationship between obstructive sleep apnea (OSA) and difficult intubation has been suggested. We hypothesized that the STOP-Bang questionnaire, a screening tool for obstructive sleep apnea (OSA), can predict difficult intubation. PATIENTS AND METHODS: In this prospective cohort study, 200 adult surgical patients undergoing surgery under general anesthesia were studied to evaluate the usefulness of the STOP-Bang questionnaire for predicting difficult intubation. STOP-Bang questionnaire results, Mallampati score and tonsil size, as well as demographic data, were recorded preoperatively. Cormack & Lehane grading and difficulty of intubation (Cormack & Lehane grade III or IV, need of an intubation aid, or need of three or more intubation attempts) were also evaluated. RESULTS: Eighty-three out of 200 patients had a high risk of OSA based on the STOP-Bang questionnaire. The occurrence of difficult intubation was higher in the patients at a high risk of OSA (i.e., a STOP-Bang score of ≥ 3) than in the patients at a low risk (13.3% vs. 2.6%) (p = 0.004). Higher age, greater weight, higher body mass index, greater neck circumference, male gender, presence of comorbidities, lower preoperative SpO2, longer extubation times, higher Mallampati score, higher Cormack & Lehane grading, tonsil size and difficult intubation were significantly correlated with a high risk of OSA (p < 0.001). Fourteen out of 200 patients had difficulty in intubation. A STOP-Bang score of ≥ 3 was seen more frequently in the difficult intubation patients (78.6% vs. 38.7%) (p = 0.009). Greater weight, greater neck circumference, greater Mallampati score, a STOP-Bang score ≥ 3 and male gender were significantly correlated with difficult intubation (p < 0.05). CONCLUSIONS: A STOP-Bang score of ≥ 3 was a predictor for difficult intubation.

Cytotoxicity evaluation of dentin contacting materials with dentin barrier test device using erbium-doped yttrium, aluminum, and garnet laser-treated dentin.

OBJECTIVES: The effect of dentin contacting materials on three-dimensional cultures of pulp-derived cells was evaluated in a dentin barrier test device using erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser-treated dentin. METHODS: The test materials (iBond(®), G-Bond™, and Vitrebond™) were applied on laser-treated or untreated dentin discs. After 24 h of exposure with perfusion of the test chamber, cell survival was evaluated by enzyme activity and related to a nontoxic control material. The mean values of control tissues were set to represent 100% viability. Data were analyzed using Kruskal-Wallis and Mann-Whitney U test. RESULTS: Vitrebond was the most toxic material for both laser-treated and untreated dentin. On untreated dentin, G-bond was cytotoxic to the pulp-derived cells (p < 0.05), and iBond was similar to the negative control group (p > 0.05). However, G-Bond and iBond were not cytotoxic when they were applied to Er:YAG laser-treated dentin (p > 0.05). CONCLUSION: Er:YAG laser treatment of dentin may protect the pulp cells from toxic substances of dentin contacting restorative materials; however, this effect is material related. Taking into consideration the limitations of this in vitro study, the Er:YAG laser treatment of dentin before restoration might be an option for decreasing the cytotoxic effects of the dental materials. Further research is required for clinical applications.

Anticancer use of nanoparticles as nucleic acid carriers.

Advances in nanotechnology opened up new horizons in the field of cancer research. Nanoparticles made of various organic and inorganic materials and with different optical, magnetic and physical characteristics have the potential to revolutionize the way we diagnose, treat and follow-up cancers. Importantly, designs that might allow tumor-specific targeting and lesser side effects may be produced. Nanoparticles may be tailored to carry conventional chemotherapeutics or new generation organic drugs. Currently, most of the drugs that are commonly used, are small chemical molecules targeting disease-related enzymes. Recent progress in RNA interference technologies showed that, even proteins that are considered to be "undruggable" by small chemical molecules, might be targeted by small RNAs for the purpose of curing diseases, including cancer. In fact, small RNAs such as siRNAs, shRNAs and miRNAs can drastically change cellular levels of almost any given disease-associated protein or protein group, resulting in a therapeutic effect. Gene therapy attempts were failing mainly due to delivery viral vector-related side effects. Biocompatible, non-toxic and efficient nanoparticle carriers raise new hopes for the gene therapy of cancer. In this review article, we discuss new advances in nucleic acid and especially RNA carrier nanoparticles, and summarize recent progress about their use in cancer therapy.

Capsicum plasters on acupoints decrease the incidence of emergence agitation in pediatric patients.

AIM: To detect the effect of capsicum plasters on bilateral HT 7 acupoints for decreasing Emergence agitation (EA) in pediatric patients undergoing tonsillectomy and/or adenoidectomy. BACKGROUND: Emergence agitation with its incidence of 10% to 80% may have deleterious effects in postoperative period. Children may harm themselves and/or care providers who require extra nursing care and additional sedatives and/or analgesics that may cause a delay in discharge from hospital. The studies dealt with the potential benefits of the use of adjuvant drugs have yielded controversial results. Some may have side effects as well as the absence of a positive effect on EA. METHODS/MATERIALS: Fifty patients undergoing elective adenoidectomy and/or tonsillectomy who aged between 2 and 10 were included to the study. Patients were divided into two groups, and capsicum plasters (acupuncture) or inactive plasters (sham) were applied on bilateral HT 7 points preoperatively. Pain, emergence agitation, and side effects were evaluated for 15 min postoperatively. RESULTS: Incidence of EA (PAED scale) (28.0% vs 60.0) and postoperative side effects was lower in acupuncture group than in sham group while there was no significant difference in the severity of EA between groups. Duration of recovery was shorter in acupuncture group. Pain scores (CHEOPS scale) were comparable between groups. EA patients were noted to have greater age and more retching than non-EA patients. Postoperative side effects such as retching, laryngospasm, and vomiting were seen more frequently in the patients with EA. CONCLUSIONS: Application of capsicum plasters on acupoints offers a valuable choice in the prevention of EA in children.

Arterial vascularisation of the anterior perforated substance.

INTRODUCTION: The arteries of the anterior perforated substance (APS) are important due to their role in supplying blood to important internal structures such as the internal capsule, putamen and caudate nucleus. The purpose of this study was to investigate in detail the arteries of the APS. METHODS: The arteries of the APS were investigated in 60 cerebral hemispheres from 30 adult cadaveric brains. The internal carotid arteries were cannulated and perfused with coloured latex. The branches of the middle cerebral artery (MCA) penetrating the APS were investigated. These arteries, known as the lateral lenticulostriate arteries and originating from the M1 segment, early temporal and early frontal branches of the MCA, were recorded. RESULTS: The branches of the anterior choroidal artery, which reached the APS, were seen in all specimens. We found one to three branches that arose from the A2 segment of the anterior cerebral artery (ACA) to the APS in all hemispheres, and one to three branches that originated from the A1 segment of the ACA in 48 hemispheres. In addition, two accessory MCAs that originated from the A2 segment of the ACA were recorded as variations, and perforating branches to the APS were observed. CONCLUSION: Serious complications like motor deficits can occur as a result of injury to the arteries of the APS. Hence, neurosurgeons performing operations such as aneurysm or insular tumour surgeries must be aware of the importance of preserving these arteries.